HESI case study – HOSPICE

1. Which statement by Jill indicates an understanding of palliative care?

a.) I will continue the previous course of treatment with the help of a home-care nurse.

b.) All of my treatments and medications will need to be discontinued.

c.) Treatments and medications will be utilized to control my pain and increase my comfort.

d.) I will discontinue any treatments and only take medications that will help my pain.

c.) Treatments and medications will be utilized to control my pain and increase my comfort.
2. Which problem should the nurse address first?

a.) The client’s need for help with hygienic activities, the primary nursing diagnosis identified by the RN.

b.) The client’s bowel and urinary elimination pattern, the priority concern of the health care provider.

c.) The problem that the client identifies as the first priority, the problem that most concerns the client.

d.) The stages of grief the family will face, the difficulty of grieving reported by the family.

c.) The problem that the client identifies as the first priority, the problem that most concerns the client.
3. Which action should the nurse take first?

a.) Suggest a routine for completing daily hygienic activities..

b. Schedule unlicensed assistive personnel (UAP) to visit twice weekly..

c.) Determine if safety equipment is needed for bathing or showering.

d.) Teach the client’s husband how to support Jill in the bathtub.

c.) Determine if safety equipment is needed for bathing or showering.
4. Which information about Jill’s care should the RN convey to the UAP?

a.) Place hygienic supplies within the client’s reach from the shower chair.

b.) Ensure that water is warmer than 120º Fahrenheit when showering.

c.) Perineal care is not necessary since vaginal secretions are decreased after the hysterectomy.

d.) The UAP should perform as much of the care as possible, conserving the client’s energy.

a.) Place hygienic supplies within the client’s reach from the shower chair.
5. When talking with the Green family, what information should the RN include? *(Select all that apply.)*

a.) Hospice care is provided only in the home care setting.

b.) Bereavement follow-up is provided after the client’s death.

c.) Interdisciplinary care focuses on symptom management.

d.) Visitation and respite services utilize only licensed personnel.

e.) The care is client and family focused.

f.) Clients are discharged if they are still alive 6 months after starting hospice.

b.) Bereavement follow-up is provided after the client’s death.

c.) Interdisciplinary care focuses on symptom management.

e.) The care is client and family focused.

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6. How should the nurse respond to Jill.

a.) Continue to offer opportunities for your daughter to talk about her feelings.

b.) I will talk to your daughter and let her know that her behavior is upsetting you.

c.) Just give your daughter time to work out her feelings on her own.

d.) Anger is typically the last stage of the grieving process.

a.) Continue to offer opportunities for your daughter to talk about her feelings.
7. Which nursing diagnosis should the RN add to the plan of care?

a.) Actual grieving related to loss of wife and mother.

b.) Anticipatory grieving related to potential loss of wife and mother.

c.) Spiritual distress related to lack of faith in possible recovery.

d.) Impaired religiosity related to terminal condition.

b.) Anticipatory grieving related to potential loss of wife and mother.
8. In which sequence does Dr. Elizabeth Kubler-Ross identify the stages of grief? (Place in order from first stage of grief through final stage of grief.)

a.) Acceptance

b.) Bargaining

c.) Depression

d.) Anger

e.) Denial

e.) Denial
d.) Anger
b.) Bargaining
c.) Depression
a.) Acceptance
9. Which technique should the RN use when communicating with Jill about her terminal illness?

a.) Avoid using humor when communicating with the client who is in a terminal stage.

b.) Utilize practices, automatic responses to questions and statements by the client.

c.) Respect the client’s pattern of communication and ways of dealing with the stress.

d.) Do not show feelings of vulnerability when communicating with the dying client.

c.) Respect the client’s pattern of communication and ways of dealing with the stress.
10. Which intervention should the nurse implement?

a.) Urge the client not to give up hope because a cure is always a possibility.

b.) Ask the client if she is interested in having a volunteer help her record her thoughts.

c.) Encourage the client to focus on herself for now and try not to worry about the children.

d.) Assure the client that her husband will be there for the children when she is not.

b.) Ask the client if she is interested in having a volunteer help her record her thoughts.
11. How should the nurse respond to the husband’s concern?

a.) You may give Jill pain medication anytime unless her respirations are less than 12 breaths per minute.

b.) It is very difficult for clients with terminal cancer to have all of their pain relieved, so Jill may have to endure pain during the night.

c.) It is impossible to overdose a client who is dying of cancer because they have built up a tolerance to the medication.

d.) We can collaborate with the primary healthcare provider to try to find a dose of pain medication that works for Jill.

d. We can collaborate with the primary healthcare provider to try to find a dose of pain medication that works for Jill.
12. Which medication does the nurse expect to give to prevent a common side effect of the Duragesic patch?

a.) furosemide (Lasix)

b.) docusate sodium (Colace)

c.) potassium chloride (Micro K)

d. diphenoxylate (Lomotil)

b.) docusate sodium (Colace)
13. Which information is most important for the RN to teach Jill’s husband?

a.) Rotate patch sites with each change every 72 hours.

b.) Eat a well-balanced diet high in B-complex vitamins.

c.) Do not apply to an area that has hair unless hair is shaved.

d.) Remove the old patch before applying the new patch.

d.) Remove the old patch before applying the new patch.
14. The morphine sulfate (Roxanol) elixir is supplied 10 mg/mL. What is the maximum volume in mL that Jill can receive per day? (Enter numerical value only. If rounding is required, round to the tenth.)

__________ mL

3.6
15. Which medication would the RN expect the healthcare provider to prescribe to treat the type of pain Jill described?

a.) meperidine hydrochloride (Demerol)

b.) gabapentin (Neurontin)

c.) naloxone hydrochloride (Narcan)

d.) propoxyphene (Darvocet)

b.) gabapentin (Neurontin)
16. Which nursing intervention describes the use of guided imagery to control pain?

a.) Visualize a pain free mental scenario while achieving a deep state of relaxation.

b.) Utilize therapeutic touch to foster emotions and release pain.

c.) Consult an acupuncturist to provide home visits for the client.

d.) Encourage the client to listen to favorite songs or sounds to distract from pain.

a.) Visualize a pain free mental scenario while achieving a deep state of relaxation.
17. Which is the best response to Jill’s husband by the nurse?

a.) Aromatherapy must be used with caution to prevent nausea.

b.) Aromatherapy is contraindicated for clients with symptoms associated with the end of life.

c.) Strong aromatic candles are usually therapeutic for terminal clients.

d.) Aromatic therapy is only therapeutic when combined with massage.

a.) Aromatherapy must be used with caution to prevent nausea.
18. Which action should the nurse take?

a.) Explain to Jill’s husband that Jill is not allowed to be hospitalized while on hospice care.

b.) Talk to Jill and her husband about the possibility of a brief hospitalization for respite care.

c.) Tell Jill’s husband that it is important that he not abandon his wife in this time of need.

d.) Recommend maintaining the current plan of care to promote stabilization for the children.

b.) Talk to Jill and her husband about the possibility of a brief hospitalization for respite care.
19. What intervention should the RN implement?

a.) Elevate the head of the bed to shunt blood to the lower extremities.

b.) Obtain a heating pad and place directly beneath the client’s extremities.

c.) No intervention is necessary for this expected finding.

d.) Place socks on the client’s feet and apply a light blanket.

d.) Place socks on the client’s feet and apply a light blanket.
20. Which interventions for the restlessness should the RN encourage Jill’s family to try? *(Select all that apply.)*

a.) Gently rub back or stroke arms.

b.) Keep the lights in Jill’s room dimmed.

c.) Avoid talking when at the bedside.

d.) Play soothing music.

e.) Apply restraints to prevent injury.

f.) Read a favorite poem or passage aloud.

a.) Gently rub back or stroke arms.

b.) Keep the lights in Jill’s room dimmed.

d.) Play soothing music.

f.) Read a favorite poem or passage aloud.

21. Which intervention should the nurse implement?

a.) Administer prescribed atropine drops sublingually.

b.) Teach the husband to count respirations every minute.

c.) Assess the client’s response to noxious stimuli.

d.) Provide vigorous nasotracheal suctioning.

a.) Administer prescribed atropine drops sublingually.
22. Which explanation should the nurse offer to the family for this change in status?

a.) This is a rare finding and may indicate that Jill’s condition is improving.

b.) This is Jill’s way of telling others she is ready to die.

c.) An unexpected alertness sometimes occurs when a client is near death and is called a “rally”.

d.) Cheyne-Stokes respirations temporarily increase oxygenation and cause this condition.

c.) An unexpected alertness sometimes occurs when a client is near death and is called a “rally”.
23. Which response by the nurse is therapeutic?

a.) Tell me about the conversations you had with Jill about this moment.

b.) I will call Jill’s primary healthcare provider to get the DNR order.

c.) Reviving Jill would only serve your interests and would not benefit Jill.

d.) Hospice nurses are not legally allowed to provide resuscitative measures.

a.) Tell me about the conversations you had with Jill about this moment.
24. Which intervention by the nurse will facilitate the anticipatory grieving process?

a.) Place a noninvasive monitor on the client so the family can determine when the heart stops.

b.) Report vital signs to the family every 15 minutes until death occurs.

c.) Encourage Jill’s husband to verbally give Jill permission to die.

d.) Recommend that Jill’s children leave the room before Jill passes away.

c. Encourage Jill’s husband to verbally give Jill permission to die.
25. Which nursing intervention is therapeutic for the family immediately after the client dies?

a.) Allow the family to spend as much time as they request at the client’s bedside.

b.) Suggest that family members join a support group for bereaved family members.

c.) Place a limit on the amount of time the family spends at the bedside after death occurs.

d.) Encourage family members to assist with post-mortem care.

a.) Allow the family to spend as much time as they request at the client’s bedside.
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